“IT CAN BE A CHAMELEON”: LEWY BODY DEMENTIA PRESENTATION WITH AN ELUSIVE CLINICAL PROFILE—CASE REPORT AND DISCUSSION

Abstract Lewy body dementia is a progressive neurodegenerative disease and is considered to be the second most common cause of dementia in the population above 65 years of age. It remains a challenging and complicated disease process to profile clinically with an elusive diagnosis that shares similarities with Alzheimer’s, leading to patients being misdiagnosed. The decline is compounded by inappropriate coordinated care efforts, and therefore ill preparing the patient and negatively affecting their relatives and support groups. We describe the case of an 83-year-old Hispanic male who over the course of 32 months sustained multiple injuries due to falls landing him in the emergency department; receiving numerous consultations from hospitalists, surgeons, infectious disease specialists, neurologists, psychiatrists, and radiologists. A combined blend of inpatient and outpatient visits was not enough to circumvent the recurrent theme that plagues similar cases worldwide with non-reliable criteria that can identify Lewy Body Dementia early in the presentation of the disease. The first mention of DLB was almost at the 32 months mark into the patient’s journey at this particular Hospital System. A multidisciplinary approach with enhanced communications and round table discussions should be a quality of care improvement initiative to help better serve this population of patients. DLB’s rapid progression and sensitive drug therapy parameters should place this as equally scalable as other multi-specialty collaborations such as tumor board, limb salvage committee, ethics, and Trauma review.

(IADLs), Activities of Daily Living (ADLs), or mobility.We used bivariate analyses to compare the unmet needs related to IADL, ADL, and mobility tasks between those living alone and those living with others.Of the 3,458 individuals identified, 28.9% (n=1001) lived alone.Those living alone were more likely to be women, unpartnered, and lacking informal caregivers.There was no difference in perceived overall health scores between the groups.Individuals living alone experienced more mobility and IADL-related unmet needs.In the month prior to survey completion, those living alone were more likely to forgo getting out of bed (p=0.031),grocery shopping (p< 0.001), cooking (p< 0.001), and paying bills (p=0.025)due to lack of available assistance.Our findings suggest that older adults living alone may need higher levels of formal assistance with IADLs to remain living in the community.Given the key role IADLs play in promoting quality of life and a person's ability to remain independent and engaged in the community, it is important to consider IADLs in addition to ADLs when assessing formal care needs for those living alone.Policy makers should prioritize the specific needs of those living alone when developing national aging strategies.

THE ASSOCIATIONS OF GRIP STRENGTH WITH CO-RESIDENCE WITH ADULT CHILDREN AND MORTALITY CHINESE OLDER ADULTS
Long Chen 1 , Shiying Gao 1 , Yan Du 2 , and Rumei Yang 1 , 1. Nanjing Medical University School of Nursing, Nanjing, Jiangsu, China (People's Republic), 2. UT Health San Antonio, San Antonio, Texas, United States Aging in place is a key to coping with population aging in China.Grip strength (GS) is one of the key determinants of aging in place.Under such a context, whether living with adult children would affect older adults' GS and mortality is worth exploring.The objective of this study was to assess the associations of GS with adult children co-residence and mortality, and examine whether the association between GS and mortality would be moderated by adult children co-residence status.We used a nationally representative sample of Chinese older adults who completed three-wave (2011, 2013, and 2015 years) of the China Health and Retirement Longitudinal Study (N=1,088, aged 50-100 years).Mortality status was determined by in-person interviews in waves 2 and 3. GS was treated as a continuous variable in mixed-effect models and a binary variable in Cox regression models (poor GS if GS< 18kg for women and GS< 28kg for men).On average, 52.2% (n=535) participants co-resided with adult children.Adult-children co-residence was longitudinally related to better GS over time (β=2.96,95% CI=0.53-3.60,p=0.009).Overall, poor GS was an independent risk factor for mortality (HR=1.33,95% CI=1.04-1.70,p=0.022) after controlling for covariates (e.g., age, sex), but this association was not modified by co-residence status (HR=1.02,95% CI=0.64-1.64,p=0.900).These results suggest that co-residence with adult children might be beneficial to better GS, which might contribute to less mortality.Future studies are needed to explore the underlying mechanisms through which the co-residence affects GS, thus, contributes to mortality.

CLINICAL PRACTICE AND HEALTH
Abstract citation ID: igad104.2253

A MOBILE HOME HEALTH CARE PHYSICIAN FOR OLDER PERSONS WITH EXTENSIVE HEALTH CARE NEEDS
Lina Emmesjö, Jenny Hallgren, Anna Dahl Aslan, and Catharina Gillsjö (Gillsjo), University of Skövde, Skövde, Vastra Gotaland, Sweden Background: The rapidly increasing older population with extensive care needs has shifted health care from institutions to the older person's home.A cross-organisational integrated care model was created by health care authorities to meet these challenges, the Mobile integrated care model.The Mobile integrated care model with a home health care physician is a collaboration between regional and municipal health care, working in the patients' home.Methods: Semistructured interviews with patients, next of kin and health care professionals.Results: The home was described by all as the best place to provide health care to these patients, creating safety and increasing autonomy for the patients.The health care professionals found trust in working together as a team, but struggled because of the divided organizations.Patients and next of kin found the Mobile integrated care model to be hierarchic, where the structure sometimes improved participation, and at other times prevented it.Conclusion: All participant groups emphasized that there was a need for more time for the health care personnel to spend with the patients.Furthermore, the patients and next of kin longed for a personal contact and being able to form a relationship with the health care personnel.The health care professionals found being employed by separate organizations as a challenge, where divided documentation systems and lack of equipment hindered the work.Lewy body dementia is a progressive neurodegenerative disease and is considered to be the second most common cause of dementia in the population above 65 years of age.It remains a challenging and complicated disease process to profile clinically with an elusive diagnosis that shares similarities with Alzheimer's, leading to patients being misdiagnosed.The decline is compounded by inappropriate coordinated care efforts, and therefore ill preparing the patient and negatively affecting their relatives and support groups.We describe the case of an 83-year-old Hispanic male who over the course of 32 months sustained multiple injuries due to falls landing him in the emergency department; receiving numerous consultations from hospitalists, surgeons, infectious disease specialists, neurologists, psychiatrists, and radiologists.A combined blend of inpatient and outpatient visits was not enough to circumvent the recurrent theme that plagues similar cases worldwide with non-reliable criteria that can identify Lewy Body Dementia early in the presentation of the disease.The first mention of DLB was almost at the 32 months mark into the patient's journey at this particular Hospital System.A multidisciplinary approach with enhanced communications and round table discussions should be a quality of care improvement initiative to help better serve this population of patients.DLB's rapid progres-Prevalence of Diabetes Mellitus Type 2 in older adults in the US is 33%, incidence of newly diagnosed diabetes is highest among those aged 65-79 years.Obesity in older adults impacts not only the morbidity and mortality, but importantly impacts quality of life and risk of institutionalization. Treatment for diabetes with glucagon like peptide 1 (GLP-1) agonists have demonstrated to reduce weight, control glucose, and reduce major adverse cardiovascular events in older adults.This study aims to describe outcomes in the management of older adults with diabetes and obesity with GLP-1 agonists.A retrospective study of 30 older adults with uncontrolled diabetes, overweight and obesity at a local practice that were started on treatment with GLP-1 agonists, since 2022, with ages 65-84 with diabetes mellitus type 2 with initial HbA1C 9.6%-12.6%,and BMI 27-48.2 that were started on GLP-1 agonists with improved results during treatment with current reduction of HbA1C 5.8%-7.7%and BMI reduction 23-39.8.In conclusion GLP-1 agonists have demonstrated significantly improved management of uncontrolled Diabetes Mellitus in older adults as well as a significant reduction in weight improving outcomes.

INTEGRAL ROLE OF SOCIAL WORKERS WITHIN A COMPREHENSIVE GERIATRIC ASSESSMENT
Ashley Schwartzkopf 1 , Jennifer Myers 1 , Cathy Schubert 1 , Lauren Penney 2 , Teresa Damush 1 , Aliana Preddie 1 , and Dawn Bravata 1 , 1.Richard L Roudebush VA Medical Center,Indianapolis,Indiana,United States,2. National Institutes of Health,Bethesda,Maryland,United States Comprehensive geriatric assessment (CGA) programs are expanding to support the wellbeing of community-dwelling older adults.Although a variety of CGA models have been described, the specific contributions of social work in CGA programs has not been rigorously evaluated.We examined the role of social work within a well-established, interdisciplinary, home-based geriatric program at one large, midwestern VA Medical Center.Semi-structured interviews were conducted with the VA-Geriatric Resources for Assessment and Care of Elders (GRACE) team to understand their perspective on social work expertise within a geriatric interdisciplinary team.Nine VA-GRACE team members were interviewed: 1 geriatrician, 1 pharmacist, 4 advanced practice nurses, and 3 social workers.VA-GRACE social workers participated in home-based CGAs by identifying psychosocial barriers that affected patients' medical care and quality of life, and engaging in ongoing case management.VA-GRACE team members valued the social workers problem-solving skills which were critical to ensuring that: patients received needed home services; caregiver needs were met; home safety and equipment issues were addressed; and patients received appropriate cognitive services.The VA-GRACE team members valued social workers for their perceived positive work ethic, as well as their critical knowledgebase which they apply to training new staff, supporting nurses (especially during periods of staff shortage), promoting patient enrollment, and developing and implementing cohesive care plans.In conclusion, these results support the integral role of social work in an interdisciplinary team providing comprehensive geriatric assessments and highlight unique contributions that